Imaging evaluation of patellofemoral joint instability: a review

The multifactorial origin of anterior knee pain in patellofemoral joint disorders leads to a demanding diagnostic process. Patellofemoral misalignment is pointed out as one of the main causes of anterior knee pain. The main anatomical risk factors of patellofemoral instability addressed in the literature are trochlear dysplasia, abnormal patellar height, and excessive tibial tubercle-trochlear groove distance. Diagnostic imaging of the patellofemoral joint has a fundamental role in assessing these predisposing factors of instability. Extensive work is found in the literature regarding the assessment of patellofemoral instability, encompassing several metrics to quantify its severity. Nevertheless, this process is not well established and standardized, resulting in some variability and inconsistencies. The significant amount of scattered information regarding the patellofemoral indices to assess the instability has led to this issue. This review was conducted to collect all this information and describe the main insights of each patellofemoral index presented in the literature. Five distinct categories were created to organize the patellofemoral instability indices: trochlear dysplasia, patellar height, patellar lateralization, patellar tilt, and tibial tubercle lateralization.